Monthly Archives: April 2021

Feeling the strain: The effects of COVID-19 on children and adolescents

By Laurie Meyers April 23, 2021

One of the most contentious — indeed, at times, vitriolic — public health debates of the COVID-19 era has revolved around the safety of opening schools for in-person classes. For some politicians, the push to open seemed to be influenced by optics — a signal that states were “open for business.” At the same time, parents have struggled to help children and adolescents with their schoolwork and other aspects of distance learning and have longed for a safe way to get back to a less chaotic educational experience. Some parents were forced to leave their jobs to take care of children and still cannot return to work. Teachers and other school staff have expressed concern for their own safety and the safety of their families and students. 

Everyone agrees that online learning is not ideal for most students — and can be virtually inaccessible for marginalized populations — but in many areas, it seemed like the safest option. However, mental health professionals, educators, parents and community activists remain apprehensive about the negative effect that the lack of in-person instruction and interaction with peers is having on the mental, emotional, social, developmental and academic well-being of children and adolescents.

There has been much confusion about how often children and adolescents get COVID-19 and how likely they are to spread the coronavirus. Recent guidance from the Centers for Disease Control and Prevention (CDC) stated that while fewer children than adults have had COVID-19 in the United States, the number of cases among school-age children was rising. Not only can children and adolescents be infected and get sick, but they can also spread the virus to others. At the same time, the CDC revised its guidance for physical distancing in schools in March, saying that 3 feet of distance (as opposed to 6 feet) is sufficient in elementary, middle and high schools where masks are worn and where community transmission is low.

In many states, teachers and other educational system personnel have received vaccinations. School districts are implementing physical distancing protocols, and the American Rescue Plan Act of 2021 passed by Congress in mid-March includes money to improve building ventilation. With these developments, many schools that weren’t already open were planning a return to in-person education, either full time or on a hybrid basis. 

Amid all the debating and planning, one group has been noticeably silent: the students themselves. Many children and adolescents are struggling with a feeling of powerlessness, says Adam W. Carter, a former school counselor who is currently the coordinator of the trauma-informed counseling graduate certificate at Northern Illinois University’s Department of Counseling and Higher Education. “We’re not asking children if they want to go back to school, if they feel safe,” he says. “We’re making decisions as adults with [the needs of] children almost as an afterthought.”

The lack of agency in decisions regarding in-person schooling is not the only area in which many children and adolescents feel voiceless, say the sources Counseling Today spoke to for this article. Like adults, children and adolescents miss their friends; are frustrated by the inability to get together with others without fear of infection; mourn the loss of celebrations and the marking of milestones; are afraid that they, or a loved one, will get sick; and are tired of spending so much time in front of a computer screen. 

In other words, they have all of the stress but not as much control as adults do, notes Carter, an American Counseling Association member. Children and adolescents often don’t know how to talk about — or, for that matter, recognize — how the pandemic is affecting them. 

For example, “Children may not know how to talk about how they miss getting together at school or with friends,” says ACA member Barbara Mahaffey, a licensed professional clinical counselor and executive director of the Scioto Paint Valley Mental Health Center in Ohio. They might ask often about visiting others but not recognize that they’re having stomachaches and other psychosomatic effects because they’re lonely, she adds. “Children may not ask for help, and parents may not recognize a child’s distress,” Mahaffey says. 

Many parents are experiencing significant worry and stress about their finances or how they can keep their family safe from COVID-19. They may also be grieving the loss of friends or family members who have died from the coronavirus. Parents often believe that it’s best to shield their children from these concerns, but the reality is that kids pick up on the underlying fear without understanding its source, say Mahaffey and Carter. 

The strain on children and adolescents is showing. According to the Nov. 13, 2020, issue of the CDC’s Morbidity and Mortality Weekly Report, child and adolescent emergency room visits related to mental health began increasing in April 2020 and remained elevated through October 2020 (the latest date for which statistics were available). Compared with the same period in 2019, emergency room visits related to mental health rose 24% for children ages 5-11 and 31% for those ages 12-17. 

Missed connections

Children and adolescents want to be with each other, Carter says. Absent in-person classes and social activities, it is difficult for them to figure out how to interact. This generation is used to socializing through social media platforms and chat apps, but after spending six to seven hours online each day for school, interest in electronic gatherings has diminished throughout the pandemic, he says. Being in the company of others all day virtually but rarely if ever getting the opportunity to interact in person has produced a particular kind of loneliness for children and adolescents.

Counselors are also finding it difficult to connect with these clients online. Once the pandemic began and counseling shifted online, Sarah Zalewski, a licensed professional counselor (LPC) who specializes in child and adolescent counseling, knew she needed a new way to engage her clients. At the time, in addition to her private practice, Zalewski was working as a school counselor in a Connecticut middle school. 

“When they come into my office, I always have toys,” she says. “They love to play, [and] I do too.”

The toys functioned as an icebreaker, with students and young clients finding it easier to open up while their hands were busy, explains Zalewski, an ACA member. But with that icebreaker gone thanks to the abrupt end of in-person sessions, she had to start thinking of alternative ways to connect. “I didn’t want to do the traditional grown-up thing, like, ‘How was your day? What was school like?’” Zalewski says.

Zalewski thought about what she had been doing herself to cope with the stresses of the pandemic. One of her favorite coping mechanisms: playing video games. Given the popularity and ubiquity of video games, she decided they might offer a great way to bridge the gap with young clients.

In the beginning, Zalewski mainly discussed the games with her clients, asking them what games they liked and why. Whenever role-playing games entered the discussion, she explored what characters her clients typically chose to inhabit. Did they pick a warrior or a priest? How was the character similar to them? How was it different? In what ways did the character reflect who the client wanted to be in real life? “Why do you want to be a druid?” Zalewski might ask. “What is it about druidism that is really cool?” 

Zalewski emphasizes that counselors who try this approach need to know or learn the language of the games. “Gaming is a culture,” she says. “Use cultural humility. If you don’t know, for example, what a druid is — [because] it’s different in different games — ask. They love to talk about it.”

Eventually, Zalewski began playing the games with her clients. They start in Google Meet, where they do all of their communicating. They then use an online link or gaming platform. Zalewski has multiple screens, and clients often use tablets. 

Sometimes the games are relatively simple. For example, Zalewski recently began playing Connect Four with a young client as an exercise in frustration tolerance (because the client doesn’t always win). When a client expresses frustration during the course of a game, Zalewski probes for the source. Is it truly about the outcome of the game itself or is it frustration at a person in the client’s life that is coming out during the gaming session? Sometimes the frustration is really about the situation that children and adolescents find themselves in with the pandemic, including feeling like they no longer have the ability to do the things they once enjoyed.

Game-based problem-solving helps clients build coping skills as they are playing, Zalewski points out. In addition, she often directs young clients to use relaxation techniques that she has taught them, such as square breathing (breathing in for four counts, holding for four counts and then breathing out for four counts).

Zalewski also likes to use Roblox, an online platform that features various games and also gives users the ability to create their own games (a function that she likens to sandbox therapy). By creating games or even leading Zalewski through a virtual obstacle course, young clients can develop a sense of leadership, she says. 

Children and adolescents are struggling with the lack of social contact during the pandemic, Zalewski says, and this is often manifesting in anxiety, depression, anger and withdrawal. The isolation is particularly difficult on clients who have depression and attention-deficit/hyperactivity disorder, she adds. 

Because physical activity helps with mood levels and basic functioning, Zalewski tries to get her young clients moving through games such as Just Dance, Ring Fit Adventure (a fantasy adventure world that uses physical exercise to navigate in-game movement), and other virtual reality games.  

To keep clients moving, Zalewski will often give clients “homework” (with parents’ permission), asking them to play a game a certain number of times between sessions. Zalewski also encourages clients to engage in social interaction. Just like any other skill, social skills will atrophy if you don’t use them, she says. 

Many role-playing games enable users to communicate with each other in chat boxes. Zalewski says there are also “clans” and “guilds” that gamers can join. Another resource she likes is Discord, a platform that allows users to discuss games and other interests on secure topic-based text channels. 

Zalewski says her clients laugh at her for her enduring love of Pokemon Go. Still, she feels it is an encouraging way for children and adolescents to get outside with parents and interact with others in a safe, physically distanced way as they collect Pokemon.  

School daze

Although some children and adolescents are doing well with virtual learning, in general, it’s not developmentally aligned to child and adolescent needs, says ACA member Jennifer Betters-Bubon, an LPC and former school counselor. “We know young kids need to move,” she says. “They thrive on environments that provide sensory stimulation and movement. Even in traditional high school, kids get to get up and move through hallways and can interact with friends.”

“We have kids who are on Zoom for hours and not necessarily getting up,” continues Betters-Bubon, an assistant professor of counseling at the University of Wisconsin-Whitewater. “It’s fatiguing for their brains and bodies, [and] it doesn’t lend itself to building relationships.”

When adults feel the fatigue of too much screen time, they can usually disconnect, at least for a little while. “When children get tired, adults are still in charge,” Carter points out. And if a child asks to take a break, parents or caregivers may think that the lack of structure will cause them to fall behind. “They may not understand that children have the same need to disconnect,” Carter says.

Betters-Bubon is noticing a lack of motivation in the children and adolescents she sees in her practice. She believes that’s in part because schoolwork isn’t as engaging without the connection to other people and the school itself. “It can feel like ‘What is the point of doing this work?’” she says. Betters-Bubon points out that on top of COVID-19, students are dealing with the impact of racial trauma and other significant stressors, all of which influence their view of whether their current math assignment is really relevant right now.

Betters-Bubon says some of her younger clients are so disengaged that she has shifted the focus of her work to their parents. She has sought to keep middle and high school students engaged by asking them to create things between sessions such as a vision board of how they’re coping with their anxiety and then sharing their creation with her.

Now that many schools are opening up, at least on a hybrid basis, Betters-Bubon and other counselors say they are witnessing excitement among students about reuniting with friends, mixed with a lot of trepidation. Many of Betters-Bubon’s clients are experiencing anxiety — about the possibility of getting COVID-19, about catching up academically or, in some cases, about starting at a new school without the normal transition. Betters-Bubon has been doing a significant amount of exposure therapy work with child and adolescent clients. This involves having them imagine a list of scary things that they might encounter and working up to doing each one in ascending order. In some cases, she has been able to reach out to school officials to ask them to allow her clients to at least see the inside of their new environment before classes start. 

Betters-Bubon acknowledges that it’s a strange new world for students returning to school. Even the nature of recess has changed. Because of the need to maintain physical distance, her son’s elementary school no longer allows balls on the playground. Students just kind of stand around and concentrate on keeping themselves separated, Betters-Bubon says. As a result, they’re not engaging those gross motor movements essential to healthy growth that they used to engage when they could run around, climb on equipment and toss balls. Betters-Bubon wonders what the implications might be if this scenario becomes normalized. 

Some schools have implemented sensory paths in hallways with different obstacles to run and jump over, Betters-Bubon says. She’d like to see more of those, particularly outdoors. Noncontact games that involve actions such as students moving to different parts of a circle can also be an excellent way to keep children moving while still remaining physically distant, she says.

LPC Melissa Brown works with an Atlanta-area community behavioral health center as a mental health counselor in a local school district with a majority Black student body, most of whom live in poverty. The community has been hit hard, both by COVID-19 itself and by the economic devastation of the pandemic-induced recession. 

The school district has been on a hybrid schedule since January. Brown has tried to give students a sense of normalcy by providing that one thing that will be consistent. “When we meet, this is going to be your safe place,” she tells students. “We can talk about anything and do anything you want.”

Many of the children still worry that they or their loved ones will get sick, so Brown holds family sessions to help students and their families develop a plan to stay safe. The children are used to having a plan for what happens if there is a fire in the school, so the idea of coming up with something similar for home seems natural to them, she says.

In sessions, they talk about teaching kids how to wash their hands, come up with examples to demonstrate what 6 feet of physical distance looks like, and discuss why they can’t see their grandmother, uncle or friends today. They also look at alternatives, such as driving by a friend’s or loved one’s house or mailing them a picture.

Brown also tells parents that they have to be honest with their children. They can’t hide information that they think might be harmful because their children are likely to be exposed to it anyway through social media, the news or friends. Instead, parents can be their children’s first source of information, Brown says.

Grief and trauma

Brown has encountered a substantial amount of grief connected to the pandemic, particularly in elementary school settings. After attending a funeral every Friday for a month, one little girl asked Brown if it was wrong that she didn’t cry anymore. 

Brown frequently uses play therapy and art therapy to help younger children explore their feelings. Eventually, the little girl was able to process her feelings and contextualize them, such as, “This person who died was a friend of my mother’s, and I didn’t really know her” and “This was my grandfather, but he was sick with cancer, and I know he’s in a good place now.”

Zalewski has helped young clients process the loss of grandparents and pets. She notes that furry family members have become even more vital companions during the pandemic. 

One child particularly liked the idea of creating a memorial for a beloved dog. So, with Zalewski’s help, the client created a space on his island in Animal Crossing, a social simulation game that gives players the ability to build and create things. Zalewski and the child found a virtual dog and gave him a red bowl to drink from. The child’s real-life dog had enjoyed being outside and sniffing flowers, so they also created a fenced-in area with flowers, the drinking bowl, a sofa (in case the dog wanted to curl up) and a radio for the dog to listen to. Players in Animal Crossing can pick the radio’s music, so the child chose happy songs because they wanted the dog to be happy.

“Creating it was very powerful, and then [the child was] able to visit [the memorial],” Zalewski said. She suggested that the child share the memorial with their mom and dad, which ended up being an emotionally significant experience. They discussed how losing the dog felt to each of them and were able to mourn together, Zalewski says. She believes the process helped to normalize grief for the child. Mom and Dad were sad too, but they were getting through it, and the client could as well. 

“Now Mom and Dad and the kid can talk more comfortably about the dog,” Zalewski says. “It’s OK to be sad. Sadness won’t break you. It’s OK to share the happy stuff too.” 

Zalewski has also helped child and adolescent clients navigate the loss of loved ones such as grandparents. Many kids are hesitant to share some of their feelings about loss because they are afraid it might be painful for the people around them, Zalewski says. She helps young clients express their grief by inviting them to have a conversation with her about the things they remember about their grandparents or other loved ones who have died. “Everyone has loss,” she says. “I help them access the good memories.” 

These memories are often funny, such as how the grandparent always made the client a cup of coffee or tea, and the client always drank it, even though they thought it tasted terrible. Or they might remember a unique sweater that their grandmother made for them. 

“Many times, kids haven’t grieved before, and they don’t know how to do it,” Zalewski says. She provides a safe place to explore the feelings of being really sad and missing a loved one.  

Moving forward

“We are not holding space for children to be scared to return to in-person learning, especially with the increased safety protocols in place,” Carter says. “Masks, no touching, no singing, playground shut down — all of these things can be scary, yet we expect children to be able to turn that off and learn as usual.”

As schools continue to open, Betters-Bubon believes that a trauma-informed approach with a schoolwide focus on relationships is essential. “Integrated within a trauma-informed approach is social-emotional learning, embedding sensory strategies into the classroom and allowing for voice and choice,” she says. “It also would include a focus on staff wellness. School counselors would focus on teaching and assisting all staff in understanding the impact of trauma on the brain and on student learning, including helping schools carve out specific ways to build relationships.”

Betters-Bubon would also like to see more collaboration between schools and outside mental health counselors to focus on building resiliency in children and adolescents. This may involve taking a wider systemic view and working with the critical adults in students’ lives, she says. “I could see an increased need for family counseling in an effort to create systemic change within families that ultimately helps children and adolescents.”

 

****

Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The future of telehealth: Looking ahead

By Bethany Bray April 22, 2021

During the COVID-19 pandemic, many counselors adapted to counseling clients via video while in-person appointments were not possible or severely restricted. Correspondingly, insurance coverage expanded and regulations regarding telebehavioral health were relaxed in many states out of necessity.

Now, as pandemic restrictions are being loosened and some helping professionals return to in-person office settings, many counselors are wondering about the future status of telebehavioral health. Will all the “old” regulations suddenly return, or will changes introduced during the pandemic remain long term?

Lynn Linde, the American Counseling Association’s chief knowledge and learning officer, says that a number of factors point toward telebehavioral health remaining a viable option for counselors in the months and years ahead.

“People have discovered that there’s a tremendous desire on the part of clients to continue telehealth, and that’s what will drive this,” says Linde, who is also a past president of ACA. “I think states aren’t going to be quick to go back to the way things were. … Counselors traditionally have not received a lot of training in telebehavioral health. We all have had to learn how to live a Zoom existence and get work done remotely — and people’s perspectives [about telebehavioral health] have changed.”

Regulation of telebehavioral health for professional counselors varies state to state. Prior to the pandemic, a handful of states had statutes that allowed for the use of telebehavioral health under counselors’ scope of practice. During the pandemic, other states relaxed and expanded the regulations surrounding telebehavioral health via executive orders from governors of regulation boards, Linde explains.

Now, more than a year later, state legislatures in several states are considering omnibus bills that would allow for the use of telehealth permanently, Linde says.

“There has been a lot of push by [state] governments for health insurance companies to cover telehealth. I think now that the efficacy of telehealth is being demonstrated, insurance companies are going to view things differently,” Linde says. “As telehealth expands, they’re going to have to rethink some of their policies around reimbursement. Some of them already are, and some states are also putting pressure on them to change. This is a huge change in the field of medicine and mental health. It’s partly counselors and clients becoming accustomed to doing things differently, and regulators and insurance companies noticing the difference.”

Telebehavioral health is also a major aspect of the interstate counseling compact project that has been gaining momentum this spring. The compact, an initiative that would allow counseling practice across state lines, is finalized and will take effect once 10 states pass legislation to adopt it. In March, Georgia was the first state to pass such legislation, followed by Maryland.

Language in the agreement ensures that any state that adopts the compact will allow counselors to use telebehavioral health permanently, Linde says. Launched in 2019, the compact project is a partnership between ACA and the Council of State Governments’ National Center for Interstate Compacts. Once a 10th state adopts the compact, it will become live and those 10 states will form its governing body.

Leaders involved in the project, including Linde, expect that the compact will reach the 10-state threshold in the summer of 2022. There is a “critical mass” of states — more than 20 — that have shown interest in joining the compact in the coming year, she says.

“It’s not a question of if we will have a compact but when,” Linde says. “We’re really seeing progress, and there is excitement [among those involved].”

Convenience and improved access

The increased use of telebehavioral health among counselors over the past year-plus has shed light on its benefits as well as how it can improve access for clients who face barriers to in-person treatment, Linde notes.

“The pandemic, in many ways, showed the deficits in our mental health delivery system,” she adds.

Telebehavioral health has allowed clients who struggle with transportation and other barriers, as well as those who live in communities or areas without a counselor, to access counseling more easily. It has also benefited college students who had to return home — often to a different state — when many campuses closed in the spring of 2020 and shifted instruction online, Linde notes.

“Necessity is the mother of invention. When everything locked down, everyone was scrambling on how to continue services. One year later, [telebehavioral health] is no longer a one-off. It’s become more of a way of doing things,” Linde says. “Counselors are trained to do face-to-face, in-person counseling. That’s our training. But we’ve seen that it is possible to pick up on some of those cues that we usually depend on seeing in person [during sessions]. It’s not the horrible situation that a lot of counselors thought it would be it. Actually, it can be very positive, and there can be benefits and time savers both for counselors and clients.”

Photograph of a person sitting with a laptop in front of them and several paper notebooks, taking notes

 

  • Read more on this topic in a feature article, “Pandemic telehealth: What have we learned?” in Counseling Today’s May magazine.
  • Find out more about the ethical standards for telebehavioral health and other important information on ACA’s COVID-19 resource page here.
  • Also see Section H, “Distance Counseling, Technology, and Social Media,” of the 2014 ACA Code of Ethics at counseling.org/ethics.

 

****

Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

A time to make dreams come true

By Caitlin C. Regan April 21, 2021

So many people dream of fame, fortune, fast cars and fancy homes. For so long now, I have dreamed of freedom — freedom to be my full true self without judgment, shame or ridicule.

So, who am I, do you ask? I am a 33-year-old female mental health counselor (and former teacher) who also has a mental health condition. I have bipolar II, and for as long as I can remember, I have had to hide part of myself because so much of society stigmatizes, judges and condemns those who have mental health conditions.

It is not that I need to wear a sign around my neck reading “Bipolar II right here,” announcing it to every stranger I meet, but do I want to live in a world where, if that was my choosing, I could do so without being judged or shamed into the darkness. I imagine that many discriminated parties understand where I am coming from and might even be saying, “At least you do get to hide it.” But that is just it — I am tired of hiding. I have spent my life living in the shadows and playing a part the world can accept.

Many people in my life are aware of my condition and accept me — for all of me. I am greatly appreciative of all the support I have received, but it is no longer enough. I want, I demand, more! I want to be able to go to work and say I have bipolar II and not have the room go silent in fear or lack of understanding. I do not want a bad day, simply because I am human and have bad days, to turn into whispers of “Is she manic?” or “Is she depressed?”

For my entire working life, I have kept my condition to myself out of fear of persecution, out of fear of my judgment being called into question because of my condition. In all those years, never once have I put a student in jeopardy (as a counselor, I am placed in a school as well) because I am fully self-aware and manage my condition as I would any other medical condition. On days when I am in a depressive episode or manic episode and am not feeling well enough to do my job, I take a sick day, just as anyone with any other medical condition would need to do.

Those with mental health conditions can thrive if they receive proper care and treatment management. In fact, there are many who have thrived throughout the ages despite having less availability to treatment than is available in the 21st century. Beethoven, Michelangelo and Abraham Lincoln (to mention only a few) all reportedly had mental health conditions, and they accomplished amazing, history-altering feats. Why then is there still such stigma surrounding mental health disorders?

Admittedly, things are better today. In the 1800s, people who were even suspected of hysterics (mostly women) were locked away. In the 21st century, we have many people who openly speak about having mental health disorders and various organizations (the National Alliance on Mental Illness, the Depression and Bipolar Support Alliance, county mental health boards, the Substance Abuse and Mental Health Services Administration, etc.) that work tirelessly to support those with mental health conditions and their loved ones. Even what I do, serving as an intervention therapist, was not heard of as recently as the 1990s and early 2000s when I was in school. 

My beginnings

When I began my journey, at 12 years old, no one knew how to help me. I was consistently described as a “freak” in my school, by students and adults alike. My parents tried to help, going to every medical doctor they could think of to discern why I was randomly fainting. It was not until years later that I was told I had conversion disorder (one’s system converts psychological symptoms to physical symptoms) and not until I was 23 that a psychiatrist diagnosed me with bipolar II. And I was 29 before receiving proper treatment that truly turned my life around.

Ironically, it was not a professional who discovered my miracle treatment. It was me, as a counseling graduate student, doing a paper on electroconvulsive therapy (ECT). Now, coming up on my four-year anniversary of receiving ECT, I am at a new place in my treatment.

I am a mental health professional myself now and experiencing lengths of stability not previously known to me. Even when I do have an episode, they are far shorter and less severe than they ever were before. Most important, I love who I am and am damn proud of myself. It is at this juncture that I want more — not for myself, but for the world of mental health. I am using my newfound stability and happiness to ask, “How can I make a difference?”

I recognize how blessed I am to have found a treatment plan and team that have helped me become the best version of myself, but I want the same thing for all who have mental health conditions, and I want it without bias. As well as I am, I still cannot go into work, sit at the lunch table and talk about my week being difficult because of a medication change for my bipolar. Well, I could, but the ramifications would be costly. For those who doubt my claim and say there are laws against that, let’s be honest. Yes, on paper, there are laws against discrimination and bias. But that does not mean that cases of discrimination and bias no longer take place on a daily basis against every “protected” group.

The fact is, in America, if you are not the “norm,” there are many who look to remove your rights as a citizen, as a person, as a human being. This can no longer be the case, and mental health needs to join the movements rising up. Those of us living with mental health conditions need to demand our right not to be judged and not to be deemed anything less than ALL of who we are. It is true that we need help, but no one goes through life without needing help. With proper treatment and active participation in that treatment, there is no reason that we cannot thrive.

Recognition and moving forward

I have rarely said this out loud. Only a chosen few have heard what I am now going to publish willingly. I think it is in part due to my bipolar that I am so creative. There is something that happens that I truly do believe stems from my condition that allows me to think at the speed I think and write while envisioning my final product (this certainly didn’t hurt during pursuit of the three master’s degrees and one bachelor’s I have earned). It also creates an empathy that allows me to place myself in the moment with people and feel with them, for them, as them.

It is true that this empathy, when I was young and did not understand what seemed an overwhelming amount of feelings, caused me a lot of pain. In return, I caused much pain to myself. But through the receipt of empathy from others and the receipt of caring treatment, I have learned how to hone those feelings and use them in my career as a counselor. I have turned my empathy into my very own “superpower” to help others who are in pain. I receive no greater joy than the work I perform as a counselor for adolescents. First as a teacher and now as a counselor to adolescents in a school, I am privileged to get to turn all I have been through into something truly meaningful.

Again though, it is not enough. Change needs to happen in this society, and I want — no, I need — to be a part of it. Not for political reasons but for humane reasons. I am a human being hurting because I do not have the ability to be my full true self. I have come to a place where I am now proud of who I am, but still I feel I cannot go into society and share my true self — and I want to.

No one should feel they have to hide a part of themselves because it does not fit the accepted “norm.” Now is the time to come together and demand change. Not just for the mental health world, but for all who feel they have to live in the shadows. Support change not because of your political party but because it is the right thing to do for all human beings.

 

Related reading: ACA Virtual Conference Experience keynote speaker Bassey Ikpi also shared her journey with bipolar II disorder. Read more in our coverage of her keynote address.

 

****

Caitlin Regan is a 33-year-old living with bipolar II disorder. She was diagnosed in 2012 and has been living successfully in treatment. She receives electroconvulsive therapy and participates in cognitive behavior therapy as her treatment plan. She is a residential therapist in an adolescent addiction treatment facility. Contact her on her mental health support Instragram account: @caitlins_counseling_corner.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Bassey Ikpi shares her gradual journey toward a healthy relationship with therapy

By Lindsey Phillips April 19, 2021

Bassey Ikpi, a spoken word poet, writer and mental health advocate, opened the third week of the American Counseling Association’s 2021 Virtual Conference Experience by sharing details from her own mental health journey. She recalled that her first encounter with mental health awareness happened in elementary school. An avid reader, she consumed whatever she could get her hands on, including her mother’s psychology textbooks and subscription to Psychology Today.

In particular, Ikpi remembers how Psychology Today’s May 1986 cover story on Howard Hughes shaped her relationship to mental health. The article discussed Hughes’ struggle with obsessive-compulsive disorder, describing in detail how he locked himself naked in a hotel room, refused to brush his teeth or cut his hair and nails, and wore Kleenex boxes on his feet.

That image would be startling to most anyone, let alone a 9-year-old, but what stood out the most to Ikpi was how no one helped Hughes. “I told myself that if I ever needed help, I’d find a way to get it,” Ikpi related to the audience for her keynote. “I never wanted to get to the point where I was wearing Kleenex boxes on my feet.”

Finding help

Ikpi, author of the bestselling memoir I’m Telling the Truth, But I’m Lying, first had serious bouts of depression during college. She said that she vacillated between being unable to sleep and unable to get out of bed, and she maxed out her credit card.

Even though Ikpi felt OK at the time, she was concerned enough to seek out the counseling services on campus. The counselor sat across from her and just scribbled in her notepad the entire session, Ikpi recalled, which left Ikpi feeling unheard and unseen. “I had walked in nervous but hopeful, and walked out discouraged and determined never to return,” she told the audience. “If this was counseling, I thought, ‘I’m good.’”

A few years later, however, Ikpi found herself in distress again when, during a hypomanic episode, she took a spontaneous trip to New York City and ended up dropping out of college and moving to Brooklyn. She hoped the move would keep her moods at bay, but it didn’t work. Ikpi sought help, but like her first experience, the therapist mainly wrote notes on a legal pad and asked clinical, nonpersonal questions. Once again, Ikpi left feeling that seeking therapy had been a waste of time.

After joining the Tony Award-winning Broadway show Def Poetry Jam, Ikpi found that her previous coping methods no longer worked, and she started to deteriorate quickly. She was losing weight, not sleeping and withdrawing. After having a breakdown backstage, the stage manager told her, “If you don’t get help, Bassey, you’re going to die.”

Ikpi left the tour the next day with a list of doctors, determined to get help. “Because of my past experiences with counseling, I walked in with an agenda. I wanted to be helped, but only as far as I would be able to accept,” she said. Her goal was to get enough help that she could return to her job.

After receiving several misdiagnoses, Ikpi walked into the office of the last doctor on her list. This therapist didn’t have a notepad. She instead had a conversation with Ikpi, and for the first time, Ikpi felt heard.

“That meeting was what began my journey toward a healthy relationship with therapy. It taught me the kind of therapy that works best for me,” she told the audience. This therapist also introduced her to another psychiatrist who gave a name to what Ikpi was experiencing — bipolar II disorder.

Overcoming the shame of mental health

Ikpi admitted that her first instinct was to keep quiet about her diagnosis out of a fear that it would change the way others perceived her. But she noticed that the shame also meant she wasn’t able to fully take care of herself.

Shortly after being diagnosed, Ikpi was watching an episode of the TV series Girlfriends in which one of the characters finds out her biological mother had bipolar disorder. Ikpi remembers thinking, “They’re going to have a conversation about bipolar disorder. That’s going to make it so much easier for me to have this conversation when I need to have it.” But the series dropped the ball, Ikpi said, because when the character asks a friend if she has inherited the disorder, the friend quickly dismisses the possibility, saying that the character is amazing, not “crazy.”

“The juxtaposition between ‘crazy’ and ‘amazing’ was trying to dispel all these things that I knew to be true about myself and my experience and my diagnosis,” Ikpi said.

Frustrated by this experience, she wrote about her diagnosis on her blog. She acknowledged to the keynote audience that this was in part a selfish act because she didn’t want to feel alone anymore and hoped to find someone else living with a bipolar disorder.

That blog post was the beginning of Ikpi finding ways to create “space for other people to name what they were experiencing, get encouragement from people and then do something about it.” Ikpi, founder of the Siwe Project, a nonprofit aimed at promoting mental health awareness in the Black community, started the global movement #NoShameDay to encourage people of African descent to share stories about mental health issues without shame and to seek help if needed.

She credits the success of #NoShameDay with the fact that “people are given permission to deal with this out loud as opposed to quietly where you can talk yourself out of it or … where you can ‘other’ yourself in a way that makes it uncomfortable to live in your own brain.”

Ikpi also told the audience it’s no coincidence that #NoShameDay falls on the second Monday in July, which is Minority Mental Health Awareness Month. While #NoShameDay day exists for everyone, it’s especially for the Black community because they are the ones who are consistently penalized for their mental health, she noted. “Our mental health is criminalized; our mental health is legislated in ways that others aren’t so [this movement] … bring[s] attention to that,” she said. The movement humanizes mental health by making “it about people’s lived experiences and their stories and not a collection of texts or a list of diagnoses.”

Growing through therapy

Ikpi compared living with an untreated mental health diagnosis with “living in a run-down house in a bad neighborhood,” where she learned how to survive and cope with what she was given. Continuing this analogy, she said that medicine allowed her to move to a better neighborhood, and therapy taught her how to traverse this new neighborhood.

“Your instinct … is to fall back on the habits that worked before. Therapy teaches me a new way to navigate when the old ways are no longer working or no longer serving my needs,” she explained.

Ikpi also shared that some people have aligned her diagnosis with her artistic ability, telling her that if she didn’t have bipolar disorder, she wouldn’t be the writer that she is. To which she responds, “I would rather not be a writer. I would give it all up. I don’t write because of bipolar disorder. I write despite it.”

“Having bipolar disorder isn’t who I am; it is what I have,” she told the audience. “It doesn’t define me anymore than being short or wearing glasses. It’s just a part of what … I have to navigate the world with.”

Ikpi concluded by reminding mental health professionals of how important their job is. “It’s a service that I don’t think is rewarded enough,” she stressed. “I would not be here — literally would not exist — if it wasn’t for the people who have made it their job to care about people like me.”

****

This keynote address is part of a month of virtual events, including hundreds of educational sessions and three additional keynotes, that lasts through April 30.

Find out more about the American Counseling Association’s 2021 Virtual Conference Experience at counseling.org/conference/conference-2021

Registration is open until April 30; participants will have access to all conference content until May 31.

****

 

Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counselors weigh in on weighted blankets

Compiled by Bethany Bray April 16, 2021

The COVID-19 pandemic has been accompanied by a range of intense emotions, and for many people, this includes acute feelings of uncertainty and worry. It seems some people have tried using weighted blankets to find comfort, as sales have increased during the pandemic.

Manufacturers often tout the blankets as a nonpharmaceutical method to help quell anxiety, sleeplessness, stress, restlessness, unease and other symptoms.

A 2015 Journal of Sleep Medicine & Disorders study by Swedish researchers found that subjects with insomnia who began using weighted blankets reported improved sleep quality, being better able to settle down to sleep and feeling more refreshed in the morning.

In the realm of professional counseling, how do these claims stack up? Are these blankets truly helpful for symptoms of mental illness? Are practitioners and clients talking about the use of weighted blankets — and their possible benefits — in counseling sessions?

CT Online collected thoughts on the use of weighted blankets from professional counselors across the U.S. Add your experience in the comment section at the end of this article.

 

****

 

The challenge to weighted blankets is that they provide physical weight but not the compression or true pressure that many with attention-deficit/hyperactivity disorder (ADHD) and autism may be seeking. Although many people do report that a weighted blanket assists in reducing their overall stress and allows more effective sleep, I believe the question really should be: Does the weighted blanket actually create those improvements, or are the reported positive changes actually due to the weighted blanket causing us to sit still for a little bit?

This slowdown during our typically fast-paced day might be a significant reason so many of us truly believe that weighted blankets help. Trend or not, I think weighted blankets show true promise in helping people learn to be more mindful of their busy lives.

I have found that weighted blankets appear to provide minimal benefits to kids with ADHD or autism. Although many of the kids I work with do enjoy the weight, parents nor children typically report significant benefits. In fact, although a large number of my families have purchased weighted blankets, very few use them on any consistent basis. I believe this is due to the concept of weight versus compression.

Although the weight can feel good, for the kids I work with, it does not provide enough sensory input to make a difference. Instead, they often seek compression or pressure.

Although weighted blanket [retailers] often talk about the “pressure” it provides, the difference is in the details. It does provide pressure, but not the deep pressure that many with ADHD or autism are seeking in times of dysregulation. In fact, kids with tactile and or proprioceptive sensory behaviors often seek out deep pressure to help regulate their nervous system. This means they often need more than what a weighted blanket can provide.

I have found that my kids who do like weighted blankets use all the weighted blankets in the house and they are oftentimes using three or four weighted blankets at once! This means the weight they are seeking is much higher than the 10% of their own body weight [that is the recommended guideline].

Although weighted blankets are definitely a trending item, I fully believe they are here to stay. However, they will probably be most useful for those who like to sleep with extra blankets purely because they like the [feeling of the] weight. For everyone else, I think compression items are often the way to go.

  • Michelle Tolison, a licensed clinical mental health counselor and owner of Dandelion Family Counseling in Charlotte, North Carolina. A registered play therapist, she works with children who are twice-exceptional (particularly those with ADHD).

 

****

 

As a child therapist, I’ve long known that occupational therapists use weighted blankets to help children with sensory issues and anxiety, including children with ADHD and autism spectrum disorder. These blankets have moved into the mainstream, but just because they’re popular does not mean they can be used to help children without first consulting a medical doctor or an occupational therapist.

A weighted blanket provides deep pressure to the body, which can help induce relaxation. However, there are physical safety concerns when it comes to children and weighted blankets. They shouldn’t be used on a child younger than 2 years old. The child needs to be able to remove the blanket themselves, and their head should never be covered. If the pellets fall out of the blanket, they can be a choking hazard. Parents should always supervise their child when using a weighted blanket.

The American Occupational Therapy Association advises against sensory-based interventions, such as weighted blankets, unless children have been thoroughly assessed. In my opinion, professional counselors are not trained to provide sensory assessments nor suggest sensory-based interventions. Suggesting a weighted blanket as an intervention for a child would be outside of the scope of our practice and could be considered unethical.

If a parent has concerns about their child’s anxiety, hyperactivity, autism, sensory processing disorder, or just an inability to go to sleep and stay asleep, I encourage them to speak to their pediatrician before they utilize a weighted blanket. Their pediatrician may recommend an evaluation by an occupational therapist.

  • Pam Dyson, a licensed professional counselor supervisor and registered play therapist supervisor in Spring Hill, Tennessee, who offers virtual play therapy supervision and consultation services.

 

****

 

During the COVID-19 pandemic, there’s no doubt that mental health symptomology is on the rise, most commonly anxiety and depression, but also for people diagnosed with autism and ADHD, since it seems to be much more of a struggle to regulate one’s emotional/behavioral state during these uncertain times. Interestingly enough, it’s also been noted that the sales of weighted blankets have increased during the pandemic. Coincidence? I think not.

Adding weight/pressure to our large muscle groups (with a weighted blanket) activates the body’s proprioceptive sensory system. Activating this system increases both dopamine and serotonin in the brain, helping people to feel more emotionally regulated, calm and in better control of their emotions and behaviors.

Dopamine is our main “feel good” neurotransmitter and main “focus” neurotransmitter. When there is an insufficient amount of dopamine being produced, retained or transported, it’s like there is a “reward deficiency syndrome” occurring. Therefore, the brain requires increased stimulation to obtain a sense of satisfaction/reward, which can be seen in the hyperactive response of those with ADHD or autism when they sensory-seek (spinning around and around) or when they novelty-seek (hanging over a two-story banister). Due to these struggles, they tend to seek excessive proprioceptive input with the intention to calm their nervous systems — but in maladaptive manners. Their excessive movement can come across as chaotic to themselves and disruptive to others.

During a pandemic, with an increased amount of time at home and without the full structure of school, clubs, organized sports, etc., that in itself can cause these symptoms to increase. A weighted blanket can assist in the retention of dopamine so these people don’t need to seek stimulation in such maladaptive manners and therefore can remain more in control of themselves. This means that a weighted blanket can be beneficial for people with autism and ADHD who have difficulty planning their movements and regulating their level of arousal. When they feel pressure from a weighted blanket on their large muscle groups, it can actually give them this proprioceptive input in a more organized manner, leading to increased attention, less internal chaos and less disruption to others.

Serotonin is a neurotransmitter that helps soothe us when we feel stressed. Serotonin is also involved in our survival mechanism to help regulate our sleep, food cravings/appetite and sexual desire. It’s involved in memory, mood/irritability levels and sensitivity/insecurity/self-confidence levels. With an insufficient amount of serotonin being produced, transported or retained, people tend to feel anxious, irritable and can have difficulty sleeping. A weighted blanket can add proprioceptive input to help retain serotonin in the brain, so one can feel calmer, soothed and more self-confident and self-secure.

Physical containment from a weighted blanket can help facilitate emotional containment [and] a sense of stability and promote behavioral regulation. (Think about it as a similar concept to “swaddling” a baby to soothe them when they are upset and to help them sleep.) It’s no wonder that the sales of weighted blankets for children and adults are on the rise during a time of uncertainty.

  • Donna Mac, a licensed clinical professional counselor at a school in the Chicago area that specializes in helping students with emotional disorders, higher-functioning autism, secondary learning disabilities and other health impairments.

 

****

 

More than one client has reported an improvement in their sleep after using a weighted blanket (or even multiple regular, heavy blankets if they couldn’t afford a weighted one) at home to give them a sense of pressure. Given all that we know now about how trauma impacts the body, it makes a lot of sense to look at as many sensory modalities as possible when working with this population.

As a personal anecdote, I have a nephew on the autism spectrum, and there was a dramatic change in his behavior after he started using a weighted blanket to improve his sleep quality at night. I do realize that the plural of anecdotes is not data, but I’ve certainly had enough positive feedback from people to suggest it to clients as an option to explore.

  • Kirsti Reeve, a licensed professional counselor at a group practice, Transcendence Behavioral Health, in Royal Oak, Michigan. She specializes in working with self-injury, teens and trauma and is also a certified drug and alcohol counselor.

 

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.